Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Patients with hypocalcemia due to resistance to parathyroid hormone (PTH) generally will require long-term therapy with vitamin D and calcium supplementation. Patients with hypocalcemia associated with chronic renal failure often require phosphate binders and vitamin D supplementation.

Calcium gluconate moderates nerve and muscle performance and facilitates normal cardiac function. It is the preferred form of calcium for patients not in cardiac arrest. One ampule contains 93 mg of elemental calcium. After IV treatment, calcium levels can usually be maintained with a high-calcium diet, although some patients also require oral calcium supplementation.

The oral formulation is usually used as supplementation to IV calcium therapy. Amounts of elemental calcium in calcium gluconate are as follows:

Calcium citrate is an oral formulation usually used as supplementation to IV calcium therapy. Calcium moderates nerve and muscle performance by regulating the action potential excitation threshold and facilitating normal cardiac function. Give the amount needed to supplement dietary intake, so as to reach recommended daily amounts. The amount of elemental calcium in 1000 mg of calcium citrate is 210 mg.

Calcitriol increases calcium levels by promoting calcium absorption in the intestines and calcium retention in the kidneys. To prevent hyperparathyroidism, patients on dialysis may require higher doses, such as 1-2 mcg/day IV administered 2-3 times per week (approximately every other day).

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Parathyroid Hormone Analogs

Class Summary

Recombinant human parathyroid hormone may be required in addition to calcium and vitamin D supplementation for hypocalcemia.

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc<br/>Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences